Shahverdyan Robert, Mehta Tej I, Inston Nicholas, Konner Klaus, Vartanian Shant
Vascular Access Centre, Asklepios Klinik Barmbek, Hamburg, Germany.
Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Eur J Vasc Endovasc Surg. 2025 May;69(5):757-765. doi: 10.1016/j.ejvs.2025.01.020. Epub 2025 Jan 23.
This retrospective, single centre, comparative effectiveness study aimed to compare the long term outcomes of percutaneous arteriovenous fistula (pAVF) and surgically created arteriovenous fistula (sAVF) created in the proximal forearm for haemodialysis access.
Data were reviewed from a prospectively maintained database on patients who underwent pAVF or sAVF creation from September 2017 to September 2023. A total of 217 pAVFs (61 WavelinQ and 156 Ellipsys) and 158 sAVFs were analysed. Outcome measures included technical success, maturation, patency, time to first successful use, re-interventions, and complications.
Technical success was 100% for sAVF and Ellipsys, and 93.4% for WavelinQ (p < .001). Maturation at four weeks was higher in Ellipsys (78.6%) and sAVF (79.7%) groups than in WavelinQ (64.9%) (p = .042). Median time to first cannulation was shortest for Ellipsys (57 days), followed by sAVF (73 days), and longest for WavelinQ (98.6 days) (p = .048). Mean follow up was 654 days (interquartile range 164, 1049 days; range 0 - 2061 days). Primary patency was higher in sAVFs than in pAVFs. The Cox proportional hazard ratio (HR) for loss of primary patency was 1.50 for WavelinQ and 1.42 for Ellipsys compared with sAVF (p = .045). Secondary patency was statistically significantly lower for WavelinQ (HR 2.76; p < .001), but not for Ellipsys (HR 0.74; p = .33). Haemodialysis access induced distal ischaemia (HAIDI) was more common in the sAVF group with nine events (5.7%) compared with one for the Ellipsys (0.6%; p = .008). Re-intervention rates per patient year were comparable across groups (0.60 vs. 0.61 vs. 0.69 for sAVF, WavelinQ, and Ellipsys, respectively).
This study indicates that while all access types can provide long term functional haemodialysis access, sAVFs perform better in some outcome domains and pAVFs (particularly Ellipsys) in others, with sAVFs showing higher rates of HAIDI, yet lower rates of juxta-anastomotic stenosis. The findings underscore the importance of personalised vascular access planning, weighing immediate procedural outcomes against long term functionality.
本回顾性、单中心、比较有效性研究旨在比较在前臂近端创建的用于血液透析通路的经皮动静脉内瘘（pAVF）和外科创建的动静脉内瘘（sAVF）的长期结局。
回顾了一个前瞻性维护的数据库中2017年9月至2023年9月期间接受pAVF或sAVF创建的患者的数据。共分析了217个pAVF（61个WavelinQ和156个Ellipsys）和158个sAVF。结局指标包括技术成功率、成熟度、通畅率、首次成功使用时间、再次干预和并发症。
sAVF和Ellipsys的技术成功率为100%，WavelinQ为93.4%（p <.001）。Ellipsys组（78.6%）和sAVF组（79.7%）四周时的成熟度高于WavelinQ组（64.9%）（p =.042）。Ellipsys首次插管的中位时间最短（57天），其次是sAVF（73天），WavelinQ最长（98.6天）（p =.048）。平均随访时间为654天（四分位间距164, 1049天；范围0 - 2061天）。sAVF的初级通畅率高于pAVF。与sAVF相比，WavelinQ初级通畅丧失的Cox比例风险比（HR）为1.50，Ellipsys为1.42（p =.045）。WavelinQ的次级通畅率在统计学上显著较低（HR 2.76；p <.001），但Ellipsys不是（HR 0.74；p =.33）。血液透析通路引起的远端缺血（HAIDI）在sAVF组更常见，有9例（5.7%），而Ellipsys组为1例（0.6%；p =.008）。各组患者每年的再次干预率相当（sAVF、WavelinQ和Ellipsys分别为0.60、0.61和0.69）。
本研究表明，虽然所有通路类型都能提供长期功能性血液透析通路，但sAVF在某些结局领域表现更好，pAVF（特别是Ellipsys）在其他领域表现更好，sAVF的HAIDI发生率较高，但吻合口近端狭窄率较低。这些发现强调了个性化血管通路规划的重要性，要权衡即时手术结局和长期功能。
